P3127 - Collagenous Gastritis: A Rare Cause of Common Abdominal Symptoms

Muhammad Asghar, MD¹, Irfa Tariq, MBBS², Hasan Shoaib, MD¹, Watcoun-Nchinda E. Pisoh, MD¹, Sonu Dhillon, MD^1
1University of Illinois College of Medicine, Peoria, IL; ²Sir Ganga Ram Hospital, Peoria, IL

Introduction: Collagenous gastritis (CG) is a very rare condition with less than 100 cases reported in the literature. CG results from the build-up of collagen in the submucosal epithelial layer of the stomach. CG is more common in young females with a suggested association to auto-immune diseases. There remains limited data as to etiology, prognosis, course, and management of collagenous gastritis. We herein present an interesting case of collagenous gastritis diagnosed incidentally in a young female significantly impacting her quality of life.

Case Description/Methods: A 27-year-old female with a past medical history of Anxiety, Depression, and Irritable bowel syndrome taking Librax, IBgard, and Dicyclomine presented to the emergency room with intermittent sharp epigastric pain, nausea, vomiting, and diarrhea for the past 4-6 weeks. The patient's symptoms were initially thought to be due to IBS flare. She underwent further evaluation with esophagogastroduodenoscopy (EGD) and was found to have localized atrophic, nodular, and scarred mucosa in the fundus, body, greater and lesser curvature of the stomach. Biopsies were consistent with collagenous gastritis. Associated autoimmune conditions were ruled out with negative ANA, celiac antibody panel, and anti-parietal cell antibodies. The patient was started on budesonide for her diagnosis of collagenous gastritis. However, she was unable to tolerate budesonide due to the side effects of intractable headaches. She was subsequently started on Pepto-Bismol 525 mg QID with remarkable improvement in her symptoms 4 weeks after initiation of Pepto-Bismol.

Discussion: Collagenous gastritis (CG) is a rare entity with a limited understanding of etiology, pathophysiology, and treatment options. The symptoms associated with collagenous gastritis include abdominal pain, nausea, vomiting, chronic diarrhea, weight loss, and GI bleeding. The reported symptoms can overlap with other common disorders including, IBS, Celiac disease, and H. pylori gastritis. The overlap in symptoms can result in misdiagnosis or delay in the diagnosis of collagenous gastritis. In our patient, her prior diagnosis of IBS was thought to be the cause of her worsening symptoms but EGD with biopsy proved her new symptoms to be secondary to collagenous gastritis.

Our case highlights the importance of timely diagnosis of this rare entity predominant in females. As such, therapies targeting CG can improve the quality of life of our patients.




Figure: (a) Nodularity and scarring in the stomach body on endoscopy
(b) Subendothelial deposition of collagen bands on histology


Disclosures:
Muhammad Asghar indicated no relevant financial relationships.
Irfa Tariq indicated no relevant financial relationships.
Hasan Shoaib indicated no relevant financial relationships.
Watcoun-Nchinda Pisoh indicated no relevant financial relationships.
Sonu Dhillon indicated no relevant financial relationships.


Muhammad Asghar, MD¹, Irfa Tariq, MBBS², Hasan Shoaib, MD¹, Watcoun-Nchinda E. Pisoh, MD¹, Sonu Dhillon, MD¹. P3127 - Collagenous Gastritis: A Rare Cause of Common Abdominal Symptoms, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.